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Neurofeedback (NFB), also called neurotherapy, neurobiofeedback or EEG biofeedback (EEGBF) is a therapy technique that presents the user with realtime biofeedback on brainwave activity, as measured by sensors on the scalp, typically in the form of a video display, sound or vibration. The aim is to provide real-time information to the Central Nervous System (CNS) as to its current activity. Some approaches believe that conscious understanding and mediation of that information is important for the training process; however, this claim has never actually been verified. Those approaches also believe that neurofeedback training can be understood as being based on a form of operant and/or classical conditioning. In that frame of reference, when brain activity changes in the direction desired by the trainer directing the training, a positive "reward" feedback is given to the individual, and if the change is in the opposite direct from what was intended, then either different feedback is given or the provision of otherwise attained "positive" feedback is inhibited (or blocked). These ideas can be applied in various combinations depending on the protocol decided upon by the trainer. Rewards/Reenforcements can be as simple as a change in pitch of a tone or as complex as a certain type of movement of a character in a video game. This experience could be called operant conditioning for internal states even though no research has yet demonstrated that clear operant response curves occur under those scenarios.
Nonetheless,a number of different brainwave goals have been proposed by different researchers in the field following on these general ideas. Usually, these goals are based upon extrapolations from research describing abnormal EEG patterns or on results from a quantitative EEG (QEEG - also known as brain mapping) upon the particular client being offered neurofeedback training. A popular goal is the increase of activity in the 12–18 Hz band (mu rhythm/ sensorimotor rhythm (SMR)) and a decrease in the 4–8 Hz and/or 22–28 Hz bands (theta and/or beta). The most common and well-documented use of neurofeedback is in the treatment of attention deficit hyperactivity disorder: multiple studies have shown neurofeedback to be useful in the treatment of ADHD  (Butnik 2005) (Masterpasqual et al 2003). QEEG has been ambivalent with some studies showing that some forms of ADHD can be characterized by an abundance of slow brainwaves and a diminished quantity of fast wave activity (Butnik 2005); however, alternative patterns have also been described making the overall picture inconclusive at this time. Some approaches believe that neurofeedback training is best done with it seeks to teach individuals to produce more normalized EEG patterns that optimize their functioning.[How to reference and link to summary or text] Some ADHD researchers are unconvinced by these studies, including the psychiatry professor and author of several books on ADHD, Russell Barkley. Barkely opines that neurotherapy's effectiveness in treating ADHD can be ascribed to either uncontrolled case studies or the placebo effect . In return, neurofeedback advocates note that Barkely has received research funds and personal remuneration from drug giant Eli Lilly and Company and other drug companies   . Other areas where neurofeedback has been researched include treatment of substance abuse, anxiety, depression, epilepsy, OCD, learning disabilities, Bipolar Disorder, Conduct Disorder, anger and rage, cognitive impairment, migraines, headaches, chronic pain, autism spectrum disorders, sleep dysregulation, PTSD and MTBI.
Other approaches to understanding and providing neurofeedback training use non-linear dynamical control processes and joint time-frequency analyses to characterize the ongoing dynamics of EEG during the training process itself. These approaches understand the functioning of the CNS in a more integrated or comprehensive fashion, including the structural ideas of the Russian neuropsychologist Luria and neuropsychiatrist Karl Pribram.
Related technologies include hemoencephalography biofeedback (HEG).
History and application
In 1924, the German psychiatrist Hans Berger connected a couple of electrodes (small round discs of metal) to a patient's scalp and detected a small current by using a ballistic galvanometer. During the years 1929-1938 he published 14 reports about his studies of EEGs, and much of our modern knowledge of the subject, especially in the middle frequencies, is due to his research (Kaiser 2005).
Berger analyzed EEGs qualitatively, but in 1932 G. Dietsch applied Fourier analysis to seven records of EEG and became the first researcher of what later is called QEEG (quantitative EEG). (Kaiser 2005)
Later, Joe Kamiya popularized neurofeedback in the 1960s when an article about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiya’s experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to distinguish between states and be correct a highly significant percentage of the time. In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Others, however, could not control it at all. Nevertheless, the results were significant and very attractive. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions. Neurofeedback appealed greatly to the social movements of the 1960s as well, when altered states were a lifestyle. For example, in 1973 Elmer Green took a portable psychophysiological lab to India to study Eastern holy men, all of whom possessed the incredible ability to control their heart rate, blood flow, and other autonomic functions, all of whom generated alpha waves continuously while doing so, according to Green’s EEG.[How to reference and link to summary or text] Despite these highly dramatic and compelling claims, the universal correlation of high alpha density to a subjective experience of calm cannot be assumed. Visuomotor activity seems to be of primary importance in alpha neurofeedback, and the ability to generate alpha with the eyes open and the lights on could develop different skills and results than if the procedure were carried out in total darkness or with the eyes closed.[How to reference and link to summary or text] Alpha states do not seem to have the universal stress-alleviating power indicated by early observations. However, this is not cause to reject the concept of biofeedback entirely. Many other biofeedback treatments have emerged, since Kamiya’s alpha experiments.
At one point, Martin Orne and others challenged the claim that alpha biofeedback actually involved the training of an individual to voluntarily regulate brainwave activity. James Hardt and Joe Kamiya, then at UC San Francisco's Langley Porter Neuropsychiatric Institute published a paper,  proving the efficacy of EEG biofeedback training, and that it was not just related to visuo/motor eyes open or closed factors.
In the late sixties and early seventies, Barbara Brown, one of the most effective popularizers of Biofeedback, wrote several books on biofeedback, making the public much more aware of the technology. The books included New Mind New Body, with a foreword from Hugh Downs, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self regulation to a switching relay which turned on an electric train.
The work of Barry Sterman, Joel F. Lubar and others has indicated a high efficacy for beta training, involving the role of sensorimotor rhythmic EEG activity. This training has been used in the treatment of epilepsy , attention deficit disorder and hyperactive disorder, and other mood disorders[How to reference and link to summary or text]. The sensorimotor rhythm (SMR) is rhythmic activity between 12 and 16 hertz that can be recorded from an area near the sensorimotor cortex. SMR is found in waking states and is very similar if not identical to the sleep spindles that are recorded in the second stage of sleep. Studies have shown that enhancement of sensorimotor activity through operant conditioning designed to increase SMR is an anticonvulsant process and is therefore an effective treatment for epilepsy.
For example Sterman has shown that both monkeys and cats who had undergone SMR training had elevated thresholds for the convulsant chemical monomethylhydrazine. These studies indicate that SMR is associated with an inhibitory process in the motor system and therefore increasing SMR through operant conditioning increases the ability to control seizures. Most individuals treated with biofeedback in research studies have been sufferers of the most severe epilepsy for whom anticonvulsant drug therapy has proven ineffective.[How to reference and link to summary or text] However, even among these most severe cases, beta and SMR training has been found to produce an average 70% reduction in seizures and to facilitate increased control of seizures in 82% of patients.[How to reference and link to summary or text]
Lubar addressed attention disorders using essentially the same protocol.[How to reference and link to summary or text] His research indicates that inhibition of motor function also inhibits input function, which is related to attention. Lubar’s protocol, which has been adopted by most practitioners as the standard protocol for treating patients with attention disorders, is to inhibit 2-10 Hz slow waves (alpha and theta) as well as 19-22 Hz waves and encouraging activity in the 12-19 Hz range.[How to reference and link to summary or text] This procedure has been supported since alpha activity is known to decrease during cognitive functions and to be inversely related to metabolism.[How to reference and link to summary or text] Lubar’s hypothesis for what is happening in an ADD brain is that there is a decreased metabolism and decreased blood flow to the subcalossol cortex. Alpha is inhibited to counter these problems.[How to reference and link to summary or text] Lubar has published 10-year follow-ups on cases and found that in about 80% of patients biofeedback can substantially improve the symptoms of ADD and ADHD, and these changes are maintained.[How to reference and link to summary or text] Currently, treatment for attention disorders is the most common application of EEG biofeedback.[How to reference and link to summary or text] However, the treatment is also effective in the treatment of traumatic head injuries and sleep disorders as well as epilepsy.[How to reference and link to summary or text]
In 1974 the pioneer Canadian psychologist (holding Registration #1 as a registered psychologist[How to reference and link to summary or text]) D.A. Quirk heard a presentation by Sterman and discussed with him the method. Quirk immediately conferred with his colleague, G.von Hilsheimer, Director of the Green Valley Psychiatric Hospital in Orange City Florida([How to reference and link to summary or text]). Quirk and von Hilsheimer began applying EEG biofeedback, training the amplitude of 4-7 Hz (theta)down, whilst training the amplitude of 13-14 Hz (sensori-motor) up over the Fissure of Roland (Ten-20 locations C-3 and C-4). From 1974 until his retirement in 1995 Quirk trained 2700 felons incarcerated at the Ontario Correctional Institute near Toronto using temperature at the left ring finger, skin conductance (palm to palm), and EEG detected at Ten-20 sites C-3 and C-4.[How to reference and link to summary or text] The three year recidivism rate for these felons was 15%, which compares well to the range of 40-70% widely reported in the correction literature.[How to reference and link to summary or text]
A significant bibliography on the efficacy of EEG biofeedback documented in refereed journals is listed at isnr.org.
For years, EEG biofeedback was treated as a minor part of the field of biofeedback, particularly by the primary biofeedback organization, AAPB. In 1993, three different efforts, somewhat overlapping, dramatically increased the energy and influence of EEG biofeedback.
In February of 1993, Rob Kall, president of Futurehealth, organized the first annual Winter Brain Meeting, in Key West Florida. The meeting brought together many of the leading figures in the field and it created a setting where the leaders could discuss and plan strategies for building greater influence and organization to move the field forward.
In April of 1993, Ken Tachiki, Jim Smith and Bob Grove organized a meeting of leaders in the field of Neurofeedback on Catalina Island, immediately before the 1993 AAPB meeting. Further planning took place at this meeting and the beginnings of SSNR occurred. SSNR= Society for the Study of Neuronal Regulation. Since then, SSNR has evolved to become ISNR International Society for Neuronal Regulation.
Immediately after the Catalina meeting, at the 1993 AAPB meeting, a new EEG section was formed, after plenty of lively discussion. It quickly grew to become the biggest section of the organization. Things were never the same at AAPB. Neurofeedback had become a mainstream part of the field, though it took a few years to fully integrate into the annual meeting and journals.
Within the last 5-10 years, neurofeedback has taken a new approach, in taking a second look at deep states. Alpha-theta training has been used in the treatment of alcoholism (first reported by Penniston in 1989[How to reference and link to summary or text]) and other addictions as well as post-traumatic stress disorder, the dysphoric disorders of women, musicians, and psychopathic offenders.[How to reference and link to summary or text] This low frequency training differs greatly from the high frequency beta and SMR training that has been practiced for over thirty years and is reminiscent of the original alpha training of Elmer Green and Joe Kamiya. Beta and SMR training can be considered a more directly physiological approach, strengthening sensorimotor inhibition in the cortex and inhibiting alpha patterns, which slow metabolism. Alpha-theta training, however, derives from the psychotherapeutic model and involves accessing of painful or repressed memories through the alpha-theta state. The alpha-theta state is a term that comes from the representation on the EEG. During this therapy, when the alpha waves amplitude is crossed over by the rising amplitude of theta waves, the state is called the alpha-theta crossover state and is associated with resolution of traumatic memories.[How to reference and link to summary or text]
The physiological mechanisms behind these therapies are very unclear. EEGs of alcoholics have revealed an inability to produce the alpha waves generally associated with feelings of relaxation and comfort.[How to reference and link to summary or text] However, following the use of alcohol, theta and alpha waves increase.[How to reference and link to summary or text] This can be expected considering the drowsiness and relaxation are common effects of alcohol. Therefore, alcoholics may be self-medicating their abnormal level of low frequency waves. Studies have demonstrated a high efficacy of alpha-theta therapy in treating alcoholism.[How to reference and link to summary or text] Peniston and Kulkosky found that while alcoholics in a control group receiving standard treatment showed significant increases in beta-endorphin levels as a result of stress caused by abstinence from alcohol, alcoholics receiving the alpha-theta treatment did not. On four-year follow-ups only 20% of the traditionally treated group of alcoholics remained sober, compared with 80% of the experimental group who received neurofeedback training.[How to reference and link to summary or text]
Low Energy Neurofeedback System (LENS)
The Low Energy Neurofeedback System (LENS) is used by approximately nearly 1,000 users around the world in twenty-two countries. It, and its antecedent systems, have been applied to well over 150,000 clients over since 1990. It uses a proprietary process as the carrier wave for the feedback. The LENS employs standard neurofeedback equipment that is unmodified in its uses with the LENS. It must have, therefore, the same "low energy" component that every other system has. The Low Energy explanation for its carrier wave has thus been eliminated in favor of one involving feedback. With this method, the EEG leads serve as bi-directional conduits for both the brainwaves and the feedback signals. This neurofeedback method is distinct in that the duration of treatment for ADD/ADHD, depression, PTSD, and seizures is claimed to be shorter than observed in traditional neurofeedback. The system settings and electrode sites change from client to client, and for any client, change from time to time. Whereas other neurofeedback approaches use operant conditioning to change brain waves, the LENS appears to interrupt the defensive looping in the brain that suppresses and cuts the connectivity needed for higher functioning. Once the EEG has been changed in response to the LENS, the LENS treatment ceases to let the person's brain re-integrate itself. This last function is usually part of the operant conditioning process of other forms of neurofeedback. It may be that the reason that the LENS approach tends to be shorter in its application to the return of function is that it lets happen spontaneously and avoids the learning tasks that are undertaken by other forms of neurofeedback, i.e., without the use of neurofeedback. It is thought that the LENS feedback lowers high amplitudes by increasing blood flow to those areas, and raises low amplitudes by releasing suppression the EEG; however these ideas need published experimental verification. Although there is now no evidence that there LENS has any more of a low energy component than any other form of neurofeedback, the name "Low Energy Neurofeedback System" (LENS) is kept for marketing reasons as this is how it has been known since 1997. Until 2006, however, only a handful of individuals knew of its existence. The 2006 publication of Dr. Stephen Larsen's book, "The Healing Power of Neurofeedback: The Revolutionary LENS Technique for Restoring Optimal Brain Function," includes case histories about the LENS technique, as well as some of its history.
Neurofeedback in practice
A common professional neurofeedback therapy nowadays goes as follows:
1. In an intake of about 90 minutes the patient will get a questionnaire and a first EEG reading. The questionnaire specifies the complaints and filters out people with serious psychological problems. The EEG serves both for diagnosis and as a reference to check later whether there is progress. In about 20% of the patients neurofeedback has no effect.
2. The EEG recording is typically done on a few dozen points on the head. It results in a brainmap ("quantative EEG"). This is a series of maps (for each frequency one) where for each measured spot the average level of activity is shown. The brainmap is compared to a database to determine spots of over- and underactivity compared to the average people of the patient's age and sex. There are several commercial providers of such databases.
3. On the basis of the complaints, the brainmap and the database results a therapy is chosen. This involves an electrode on a single spot on the head that needs to become more or less active for specific frequencies. During the therapy the patient gets feedback that helps them improve. This feedback may involve for example a simple light or tone, some game where "good" brainwaves are rewarded and "bad" ones punished or some image that becomes less sharp when the patient loses focus.
4. A typical therapy takes 20 to 40 sessions. Some forms of psychotherapy are considerably faster, so neurofeedback is not always the most efficient solution. At the beginning of each session the patient reports the course of his complaints and also mentions other mental effects. On the basis of this report the therapy may be adjusted. In some cases a patient is allowed to take a feedback machine home and have most - but not all - sessions there.
Criticisms and recent court cases
"Neurofeedback is being used as an addition to many psychotherapists' practices as a boost to a sagging 'talk-therapy' practice Since in most states there are no licensing requirements, therapists who have little knowledge of physiology or computer technology can use the equipment with little oversight. The client can be hooked up and the computer program does the training with little effort on the therapist's part. It adds a high-tech effect to the session and makes the whole procedure seem more credible.
In the Gravelle case in Huron, Ohio, 11 adoptive children were given thousands of hours of neurofeedback training at a great cost to the county with seemingly little improvement in their conditions. The criticism is that neurotherapy was given to them for an array of different problems simply because the funds were so easily available.
Parapsychologists and less mainstream users of neurofeedback
Some neurofeedback equipment companies make claims based on the scientific appeal of electronics and the mysteries of the brain. For example, some brain training products are sold to consumers promising to raise IQ and self-esteem, or to enable zen meditative and deep hypnotic states. Furthermore, paranormal abilities such as remote viewing, past life regression, and other psychic phenomena are claimed by some marketers to commonly result from use of their neurofeedback machines or programs.[How to reference and link to summary or text]
- Binaural beats
- Brainwave synchronization
- Comparison of neurofeedback software
- Evoked potential
- Event-related potential
- Human enhancement
- Induced activity
- Intelligence amplification
- Mind machine
- Neural oscillations
- Neurofeedback Systems & Equipment
- Ongoing brain activity
- Butnik, Steven M. "Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder." Journal of Clinical Psychology, May 2005. Vol. 61 Issue 5, p621-625
- Evans, J.R., and Abarbnanel, A. An introduction to quantitative EEG and Neurofeedback. Academic Press: San Diego, 1999.
- Hammond, Corydon D. "Neurofeedback Treatment of Depression and Anxiety." Journal of Adult Development, Vol 12, Nos. 2/3, August 2005
- Kaiser, David A. "Basic Principles of Quantitative EEG." Journal of Adult Development, Vol. 12, Nos. 2/3, August 2005.
- Masterpasqual, Frank and Healey, Katherine N. "Neurofeedback in psychological practice." Professional Psychology: Research & Practice. Dec 2003, Vol. 34 Issue 6, p652-656
- Trudeau, David L. "EEG Biofeedback for Addictive Disorders -- The State of the Art in 2004." Journal of Adult Development, Vol 12, Nos. 2/3, August 2005.
- Vernon, D. (2005). Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Applied Psychophysiology and Biofeedback, 30(4), 347-364.
- The Principal Frequency Bands—simplified
- Common Applications Page
- BBC article about neurofeedback improving the performance of musicians
- CNN article about growing field of bio- and neuro-feedback
The following are organizations involved in research and development:
- The International Society for Neuronal Regulation hosts annual professional conferences, and publishes a peer-reviewed journal that focus on neurofeedback.
- The Association for Applied Psychophysiology and Biofeedback hosts an annual and regional professional conferences on applied psychophysiology including neurofeedback. They have published a peer reviewed journal since about 1975.
- The EEG and Clinical Neuroscience Society is a medical EEG society that includes the exploration of neurofeedback in its statement of intentions, and publishes relavent articles in its journal Clinical EEG.
- The Biofeedback Certification Institute of America is the recognized certification organization for licensed professionals competent in applied psychophysiology, including neurofeedback.
- The Brian Othmer Foundation is affiliated with the EEG Institute, and explore neurofeedback technologies in a variety of contexts.
The following are some links to unconventional users of neurofeedback:
-  Psychic and spiritual development
-  Psychic and spiritual development, and mind power
-  Neurofeedback and Psychic and spiritual development
-  Neurofeedback and Remote viewing
-  Neurofeedback and past life regression
-  Neurofeedback and subliminal messages
- EEG Spectrum International, Inc. is a corporation whose pledge is to "promote the achievement of full human potential through brain-based self-regulation techniques, and to help evolve human consciousness through the exploration and development of advanced technologies for self-regulation, self-awareness and self-knowledge".
- OpenEEG is an open source hardware and software project for amateur and professional neurofeedback practitioners alike.
- The Learning Curve, Inc. (TLC) is a private company who provides assessment and training services and equipment for individuals interested in adopting neurofeedback into their personal or professional practice.
- BioEra software that allows to create custom processing designs visually. Works on many operating systems (Windows, Linux, PDA) and supports variety of biofeedback devices.
- BioExplorer software works with many hardware platforms and provides a wide range of options for creating and modifying neurofeedback design protocols.
- www.eeginfo.com is a website that is obviously linked to certain companies and products but lends much to the availability of internet resources on the subject, dubbing itself "The Complete Neurofeedback Resource".
- www.ochslabs.com is a proprietary website that is the authoritative source of information about the Low Energy Neurofeedback System (LENS), training, and practioners trained to use the system.
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